| Stage | Definition | Valve anatomy | Valve hemodynamics | Hemodynamic consequences | Symptoms |
| A | At risk of AR | - Bicuspid aortic valve (or other congenital valve anomaly)
- Aortic valve sclerosis
- Diseases of the aortic sinuses or ascending aorta
- History of rheumatic fever or known rheumatic heart disease
- IE
| - AR severity: None or trace
| | |
| B | Progressive AR | - Mild to moderate calcification of a trileaflet valve bicuspid aortic valve (or other congenital valve anomaly)
- Dilated aortic sinuses
- Rheumatic valve changes
- Previous IE
| - Mild AR:
- Jet width <25% of LVOT;
- Vena contracta <0.3 cm;
- RVol <30 mL/beat;
- RF <30%;
- ERO <0.10 cm2;
- Angiography grade 1+
- Moderate AR:
- Jet width 25 to 64% of LVOT;
- Vena contracta 0.3 to 0.6 cm;
- RVol 30 to 59 mL/beat;
- RF 30 to 49%;
- ERO 0.10 to 0.29 cm2;
- Angiography grade 2+
| - Normal LV systolic function
- Normal LV volume or mild LV dilation
| |
| C | Asymptomatic severe AR | - Calcific aortic valve disease
- Bicuspid valve (or other congenital abnormality)
- Dilated aortic sinuses or ascending aorta
- Rheumatic valve changes
- IE with abnormal leaflet closure or perforation
| - Severe AR:
- Jet width ≥65% of LVOT;
- Vena contracta >0.6 cm;
- Holodiastolic flow reversal in the proximal abdominal aorta
- RVol ≥60 mL/beat;
- RF ≥50%;
- ERO ≥0.3 cm2;
- Angiography grade 3+ to 4+;
- In addition, diagnosis of chronic severe AR requires evidence of LV dilation
| - C1: Normal LVEF (≥50%) and LVESD ≤50 mm
- C2: Abnormal LV systolic function with depressed LVEF (<50%), LVESD >50 mm, or indexed LVESD >25 mm/m2
| - None; exercise testing is reasonable to confirm symptom status
|
| D | Symptomatic severe AR | - Calcific valve disease
- Bicuspid valve (or other congenital abnormality)
- Dilated aortic sinuses or ascending aorta
- Rheumatic valve changes
- Previous IE with abnormal leaflet closure or perforation
| - Severe AR:
- Jet width ≥65% of LVOT;
- Vena contracta >0.6 cm;
- Holodiastolic flow reversal in the proximal abdominal aorta;
- RVol ≥60 mL/beat;
- RF ≥50%;
- ERO ≥0.3 cm2;
- Angiography grade 3+ to 4+;
- In addition, diagnosis of chronic severe AR requires evidence of LV dilation
| - Symptomatic severe AR may occur with normal systolic function (LVEF ≥50%), mild to moderate LV dysfunction (LVEF 40 to 50%), or severe LV dysfunction (LVEF <40%)
- Moderate to severe LV dilation is present
| - Exertional dyspnea or angina or more severe HF symptoms
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